Thrombophilia in pregnancy: a systematic review

Robertson, L. et al. (2006) Thrombophilia in pregnancy: a systematic review. British Journal of Haematology, 132(2), pp. 171-196. (doi: 10.1111/j.1365-2141.2005.05847.x)

Abstract

Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0·74–34·40); early pregnancy loss (ORs, 1·40–6·25); late pregnancy loss (ORs, 1·31–20·09); pre-eclampsia (ORs, 1·37–3·49); placental abruption (ORs, 1·42–7·71) and intrauterine growth restriction (ORs, 1·24–2·92). Low-dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1·62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.

• Item Type: Articles
• Keywords: Thrombophilia, pregnancy outcomes, systematic review.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Twaddle, Dr Sara and Greer, Prof Ian and Wu, Professor Olivia
• Authors: Robertson, L., Wu, O., Langhorne, P., Twaddle, S., Clarke, P., Lowe, G.D.O., Walker, I.D., Greaves, M., Brenkel, I., Regan, L., and Greer, I.A.
• Subjects: R Medicine > RC Internal medicine; R Medicine > RG Gynecology and obstetrics
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
• Journal Name: British Journal of Haematology
• Journal Abbr.: Br. J. Haematol.
• Publisher: Blackwell
• ISSN: 0007-1048
• ISSN (Online): 1365-2141
• Published Online: 15 November 2005
• Copyright Holders: Copyright © 2006 Blackwell
• First Published: First published in British Journal of Haematology 132(2):171-196
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.